title: Paper 4: EUROCAT statistical monitoring: identification and investigation of ten year trends of congenital anomalies in Europe.
abstract: BACKGROUND
  As part of EUROCAT's surveillance of congenital anomalies in Europe, a statistical monitoring system has been developed to detect recent clusters or long-term (10 year) time trends. The purpose of this article is to describe the system for the identification and investigation of 10-year time trends, conceived as a "screening" tool ultimately leading to the identification of trends which may be due to changing teratogenic factors.
  
  
  METHODS
  The EUROCAT database consists of all cases of congenital anomalies including livebirths, fetal deaths from 20 weeks gestational age, and terminations of pregnancy for fetal anomaly. Monitoring of 10-year trends is performed for each registry for each of 96 non-independent EUROCAT congenital anomaly subgroups, while Pan-Europe analysis combines data from all registries. The monitoring results are reviewed, prioritized according to a prioritization strategy, and communicated to registries for investigation. Twenty-one registries covering over 4 million births, from 1999 to 2008, were included in monitoring in 2010.
  
  
  CONCLUSIONS
  Significant increasing trends were detected for abdominal wall anomalies, gastroschisis, hypospadias, Trisomy 18 and renal dysplasia in the Pan-Europe analysis while 68 increasing trends were identified in individual registries. A decreasing trend was detected in over one-third of anomaly subgroups in the Pan-Europe analysis, and 16.9% of individual registry tests. Registry preliminary investigations indicated that many trends are due to changes in data quality, ascertainment, screening, or diagnostic methods. Some trends are inevitably chance phenomena related to multiple testing, while others seem to represent real and continuing change needing further investigation and response by regional/national public health authorities.
authors.affiliation: EUROCAT Central Registry, Centre for Maternal, Fetal, and Infant Research, University of Ulster, Newtownabbey, Co Antrim, Northern Ireland, United Kingdom. ma.loane@ulster.ac.uk
authors.forename: Maria
authors.initials: M
authors.lastname: Loane
authors.forename: Helen
authors.initials: H
authors.lastname: Dolk
authors.forename: Alan
authors.initials: A
authors.lastname: Kelly
authors.forename: Conor
authors.initials: C
authors.lastname: Teljeur
authors.forename: Ruth
authors.initials: R
authors.lastname: Greenlees
authors.forename: James
authors.initials: J
authors.lastname: Densem
mesh_terms: D001699:Biometry; D002887:Chromosomes, Human, Pair 18; D000013:Congenital Abnormalities / Q000453:epidemiology*; D016208:Databases, Factual / Q000639:trends*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D020139:Gastroschisis / Q000453:epidemiology; D017408:Guidelines as Topic; D006801:Humans; D007021:Hypospadias / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance; D011247:Pregnancy; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data*; D013723:Teratogens; D014314:Trisomy
chemical_list: D013723:Teratogens